Background/Purpose: National health authorities reported a prevalence of SARS-CoV-2 infection around 7% of the general population in Barcelona county (1). A recent report focused on autoimmune and immune-mediated inflammatory disease (AI/IMID) in Spain reported a slightly higher prevalence than in general population, especially in patients under targeted therapies and patients with systemic disease (2). Our aim was to analyze clinical characteristics and outcomes in a multidisciplinary cohort of patients with AI/IMID and symptomatic COVID-19 infection in a single tertiary center.

Methods: We included confirmed cases with RT-PCR SARS-CoV-2 test positive after nasopharyngeal swab according to Microbiology registry from Hospital Clinic of Barcelona from the 1st of March until May 29^th, 2020. Data was matched with our registry of AI/IMID diseases. Additionally, patients under clinical follow-up for AI/IMID underwent a telephone survey to establish probable cases according CDC classification. We evaluated clinical characteristics and COVID-19 outcomes including clinical complications, need for ICU admission, and death as well as markers of systemic inflammatory response.

Results: From a total of 1,709 patients who gave positive for RT-PCR SARS-CoV-2, we identified 1,448 single patients.  Around 5.000 patients with AI/IMID are under follow-up in our center. Thirty-one patients (23 female) with AI/IMID were identified, with a median age of 53 (IQR 25) years. Twenty-six cases were confirmed by PCR and 5 were diagnosed as probable cases. Main comorbidities included hypertension in 32% of cases and chronic pulmonary disease in 16%. Rheumatoid arthritis and inflammatory bowel disease were the most common diseases in 29% and 22%, respectively. Clinical characteristics of COVID-19 patients with AI/IMID are summarized in Table 1. Nine (29%) out of 31 patients were under glucocorticoid treatment (mean dose 7.0 ± 5.5 mg/d), 4 (12.9%) under hydroxychloroquine (HCQ), 9 under methotrexate (29%), and 8 (25.8%) under targeted synthetic/biologic DMARDs (mainly TNF inhibitors). A total of 16 (51%) patients had pneumonia and required admission. There were no differences between admission rates according to age, gender, underlying diagnosis, or baseline treatment. Most patients (87%) received the institutional standard treatment for COVID-19 with Lopinavir/ritonavir, HCQ and azithromycin. One patient had renal insufficiency and a pulmonary complication that resolved before discharge. Only 1 patient required ICU admission and another patient died due to COVID-19 infection. Characteristics and clinical outcomes of patients admitted due to COVID-19 are summarized in Table 2. During admission, immunosuppressive therapies were stopped in 7 (43%) cases and ts/bDMARDs in 3 (18%) cases. Four patients presented a clinical flare.

Conclusion: In our center, less than 1% of patients with AI/IMID had symptomatic COVID-19 infection. Most patients had a satisfactory outcome; including patients under ts/bDMARDs and clinical fares during admission and follow-up were uncommon. We are running comparative analysis with other populations and evaluating the prevalence of asymptomatic COVID-19 infection in patients AI/IMID.

Table 1. General characteristics of symptomatic COVID-19 patients with AI/IMID

Table 2. Characteristics and clinical outcomes of patients admitted due to COVID-19

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-multidisciplinary-registry-of-patients-with-autoinmune-and-immune-mediated-diseases-with-symptomatic-covid-19-infection-from-a-single-center/